N0042119P0704_J&A.pdf

NAVSUPINST 4200.85D

XX MONTH 200X

JUSTIFICATION FOR SOLE SOURCE (Simplified Acquisitions <$150k)

The service or material listed on Procurement Request (PR) number is sole source and competition is precluded for reasons indicated below. There are no substitutes available for this service/material.

The following firms were contacted and have indicated that they cannot provide an item/service that will meet the needs of the Government.

Company Person Contacted Date of Call Reason -

Reason:

Reason:

Restricted to the following source. Provide original manufacturer’s name. (If a sole source information manufacturer distributes via dealers, ALSO provide dealer information.)

Manufacturer: POC:

Manufacturer’s Address:

Manufacturer’s Dealer/Rep: Phone

Description of the item:

Estimated cost: Required delivery date:

Specific characteristics of the material or service that limit the availablity to a sole source (unique features, function of the item, etc). Describe in detail why only this suggested source can furnish the requirements to the exclusion of other sources. (Explain)

CHECK & FILL IN ALL APPLICABLE BLANKS BELOW

The requested material or service represents the minimum requirements of the government.

The material/service must be compatible in all aspects (form, fit and function) with existing systems presently installed. Describe the equipment you have now and how the new item/service must coordinate, connect, or interface with the existing system. (Explain)

A patent, copyright or proprietary data limits competition. The proprietary data is: (Explain)

These are “direct replacements” parts/components for existing equipment.

Other information to support a sole-source buy: (Explain)

I CERTIFY THAT STATEMENTS CHECKED, AND INFORMATION PROVIDED ABOVE, ARE

COMPLETE AND CORRECT TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT THE

PROCESSING OF THIS SOLE-SOURCE JUSTIFICATION PRECLUDES THE USE OF FULL AND

OPEN COMPETITION.

Signature:________________________________ Activity:

Title: Date:

Contracting Officer’s Signature: ____________________________________ Date: _____________________

SAP SOLE SOURCE